- Highmark Health (Buffalo, NY)
- …POSITION IS ON-SITE** **ONLY This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses ... coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Elevance Health (New York, NY)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and accurate… more
- KidsPeace Childrens Hospital (Kingston, NY)
- This position is responsible for providing skill building by addressing the behavioral health care needs of children based on established treatment goals and ... described in the job duties below. QUALIFICATIONS: Must be a Licensed Behavioral Practitioner in one of the following fields: Psychoanalyst, Clinical Social Worker,… more
- Project Renewal, Inc. (New York, NY)
- …care screenings, substance abuse treatment programs and treatment of chronic disease and behavioral health . Tasks include, but are not limited to: + Expanding ... with clinical staff and collaborative partners to provide administrative and relationship management support to Project Renewal's Mobile Health Program. Working… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …complex assignments, difficult members and highly visible issues.* Understanding of the basic Utilization Management and Case Management aspects of the ... in their home and/or facility. The incumbent utilizes required NYS Community Health Assessment (CHA) Tools to determine functional status, medical, behavioral ,… more
- KidsPeace Childrens Hospital (Kingston, NY)
- This position is responsible for providing skill building by addressing the behavioral healthcare needs of children based on established treatment goals and Early ... described in the job duties below. QUALIFICATIONS: + Must be a Licensed Behavioral Practitioner in one of the following fields: Psychoanalyst, Clinical Social Worker… more
- Elevance Health (Latham, NY)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- Highmark Health (Albany, NY)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Highmark Health (Buffalo, NY)
- …in Enrollment + 3 years in Benefits Administration + 3 years in Utilization Management **Preferred** + None **LICENSES AND CERTIFICATIONS** **Required** + None ... Service + Billing Systems + Benefit Coding + Enrollment Systems + Utilization Management Systems **Language (Other than English):** None **Travel Requirement:**… more
- Trinity Health (Troy, NY)
- …social worker to join our teams in the Capital Region. Ambulatory Care Behavioral Health Social Worker provides advanced clinician social work services, care ... planning, case management , and community resource coordination to patients and their...in QI initiatives within the hospital ambulatory setting. The Behavioral Health Social Worker plays a significant… more